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^ • <br />1. <br />2. <br />3. <br />4. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES /y\ <br />(Ordinance No. 164, Second Series - Adopted 12/06/97) <br />m Make check payable to: City of Orono <br />Mailing address:P.O. Box 66 <br />Crystal Bay, MN 55323 <br />FEE: $100.00 (February 1-January 31)h 10-OS' <br />DATE <br />Applicant's Full Name <br />_____firo.A'V______1 <br />FIRST MIDDLE LAST <br />Applicant's Home Address <br />____^/O a). SKftfc (Sr • ‘_____ <br />HOUSE NUMBER STREET HOME PHONE <br />CITY STATE <br />Applicant's Business <br />Go/Z Coatic. <br />i)F BUSINESS <br />>3V^9 <br />TYPE OF Bl <br />/vCiKe(/itto GoIL rf, 0ro>'O^ ^Cnc. <br />BUSINESS NAME <br />*TI O a). Skoft, Dr • W • <br />rv\(iu^ij mrJ _____ <br />MAILING ^DRESS <br />BUSINESS PHONE <br />HoS t\)\ Pfm • <br />STREET ADDRESS <br />Oron'i ^ <br />CITY <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobacco related device between the customer and the licensee or employee takes <br />pi ace. Oushmer ajfCj -Jo 4i)feacco J>ru«iiu4'• Cuiiont/* <br />_ iQir-^. jiyA, Sr. IKcX-|9 U)‘H Cijlc. Xb 0(/^ vcixicto pixctiic^^ <br />'Fki^ i* ^ irctirttC olratJ*'V Vfio \ ■/r^fow\ Sfra rt^L __ <br />\ ^ ■> <■ <br />i HEREBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO. TOBACCO >? J <br />PRODUCTS, OR TOBACCO RELATED DEVICES AT THE ABOVE LOCATION SUBJECT j <br />V • •• Tn TLJC I A lA/o r\c ’rue ota rc r\e kJikiKieor\rA Akir\ "^ue r\Dr\ikiAki/^ec* rue r^ir\/ • <br />V. <br />i ♦